Edelquinne Ann Jacildo

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ01373900 Issued in NJ

Practice address

106 Centre Blvd Ste G
Marlton, NJ 08053-4131

Phone

(856) 797-2810

NPI assigned

Sep 28, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

New Age Behavioral PCGroup PAC ID 4688895717, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Age Behavioral PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Marlton, NJ
  • NPI 1689089344
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1639893274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 CENTRE BLVD STE G",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CENTRE BLVD STE G",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534131",
            "telephone_number": "856-797-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACILDO",
        "first_name": "EDELQUINNE",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01373900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• IV National LLC
• Iva Kirzhner LCSW LLC
• Monisha Iyer, DMD
• Ja Vue Inc.
• Amira Jabbar
• Teresa B Jackson, HIS
• Danielle Marie Jacobs
• Samantha Raven Jaconetti
• Brian Jaffe, MD
• Yvette Jamison, LSW

• Psychiatric/Mental Health Nurse Practitioner in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.